Saturday, February 24, 2018

Get Out Alive Blocked Cat Episode.

The cases that move me are not the easy quick ones.

Life works that way. Your greatest rewards often lie in the trenches during the greatest conflicts. It is our version of the battlefield stories that bond us in our darkest hours.

Yesterday was one of those days. (I seem to live in these days these days).

We get a call that goes something like this; (I only heard one side of the conversation. My receptionists side).

"I'm sorry to hear about your cat. You say that you found a clinic that would give your cat a free examination, (clearly a corporate marketing tool to drum up new clients I thought?), and, they say your cat is blocked? (A blocked cat is a cat who cannot pee and this is ALWAYS an emergency!)." long pause.. "I'm sorry did you say that you have seven (7????) dollars?" Her voice took a tragic upturn on the dollar sign part.

...short pause.....

"Ok, well,,, umm,,   (pause)      ummm,,, (deep swallow),,, let me get your information and I will call you right back." My receptionists are seasoned pros. They hardly get flustered. But, then again, who calls with $7?

At this point everyone within ear shot was huddling around her desk with muffled giggling. This is the giggle of the great battles. The first shot has been fired, the troops are gathering and a plan is about to be hatched. These are the stories of the place Jarrettsville Vet has become. These are the stories other vets get, most sarcastically laugh at and dismiss, disregard, or decide to just be bitter about. I was/am/try very hard NOT to be this person. I pay for electricity, wages (waaay above minimum btw) and blah, blah, blah, (excuses to not care), but it doesn't change the fact that there is still this guy, AND, there is still this cat.... so we listen to the stories. We gather the troops, and we devise a plan. The plan is always a conversation, a compromise and a quest. The goal however is always mutually consistent in the most critical component: We have to act fast AND we feel compelled to get help. We place phone calls. We are a place that listens and lives by our motto 24/7/365.

After a round table discussion we formulated a preliminary plan. The first phone call was back to the cats dad. We have a team dedicated to returning these phone calls. We have a shield for them in our first line of defense, our receptionists, then the team takes over. No one should be the single troop in a militia. The first test is in assessing the pet parents intention and integrity. He has to be able to compromise. Turns out he also has to be one other thing.. completely dedicated to his pet and follow through with our advice so we don't perpetuate another terrible predicament. Vitally important to the success of these cases is that he has to participate in this cats treatment, recovery and long term care. Thankfully we discover that he loves his cat and he is willing to do whatever he needs to keep him healthy. I can do just about anything as long as we start here. Everyone has to invest in CARING. Nothing of merit lives outside of caring.

Next step in the plan of attack;

We called our friends at the rescue. Circle the wagons, build momentum by uniting the troops. They have the ability to manage this cats care after we get him unblocked. They can manage the nursing care for the next few days while he gets his bladder and kidneys diuresed. It is nothing more than a medically induced flushing of his urinary system. "The solution to pollution is dilution."

They offered to pay for his after care. We would get him unblocked. Two phone calls and we are on our way to saving this cats life. Go Team GO!

An hour later we met Socks.. As always (ok,, truly always), the ones who need you the most are the ones who are the sweetest souls. This cat was pure love. Young, adorable, and desperate to pee. He purred the entire time we squeezed his rock hard massively overfilled bladder.



Here is his story in synoptic detail, video style.



There are articles and discussions of this condition listed below. While I am not here to argue that there are absolute benefits to maintaining ideal standards of care I firmly beleive that the biggest failure we provide is not offering assistance regardless of clients financial abilities. When we as a profession decide collectively to support our patients first I will with hold posting prices and offering cost saving options. Get Out Alive series is coming. Blocked Cats is first on my list. Next, pyometras.


The typical cost of a blocked cat at my clinic is;
Exam; $50 to $75
Radiograph $100 *
Intravenous catheter $40
Intravenous fluids $40
Intravenous fluid pump $40
Anesthesia $100
Urinary catheter placement $75
Hospitalization care about $100 per day. Usually stays for 3-5 days.
Bloodwork $150 *
Urinalysis $50 *

* optional if client cannot afford it.

For more information please see these articles;

Urinary Obstruction in Male Cats, ACVS article. One of the best on this condition. Please read this one!

Feline Urethral Obstruction: Diagnosis and Management. By Today's Veterinary Practice. A very thorough description of how, why and what happens to these cats along with detailed description of treatment options. I recommend taking this article and discussing each step with your veterinarian as they provide an estimate for the cost of care. Know how much each step costs, know where your cat falls within the spectrum of the disease process and know that one size does not fit all! You may be able to cut some costs with the use of this step by step guide. Get everything in writing and GET OUT ALIVE!

A protocol for managing urethral obstruction in male cats without urethral catheterization. Cats were treated in a hospital but not catheterized (which I feel is the most important part of the treatment plan). Read carefully and understand this protocol cannot, and should not, be  accomplished at home.

Controversies in the management of feline urethral obstruction. Journal of veterinary emergency medicine. 2015, PubMed. Please read the prognosis section; "Feline urethral obstruction is associated with 90-95% survival, with reported recurrence rates of 15-40%." How many people cannot afford to treat their cat when the survival rate is this high? I would guess that there is not a single other emergency condition that pets get that has this high of a survival rate when compared to the number of economic euthanasia's due to cost. What is the rate of economic euthanasia for this condition? At my clinic it is zero. What is it elsewhere? (Good question? Anyone want to share their numbers? Speculative numbers?)?

Can these cases be managed at home? Without a veterinarians intervention or assistance? I would strongly discourage this. I feel the prognosis is far better with a urinary catheter placed and intravenous fluid therapy to flush the bladder, kidneys and remove the toxins and systemic imbalances, but here is a widely cited article on managing these cases at home. Which is better than nothing (although I would still argue it isn't enough!).

If you have questions about your cats care, the cost associated with this diagnosis and most importantly ever feel pressured to euthanize based on economics please ask/beg/insist on options and please seek a second, third, or even fourth opinion so that your treatable cat can GET OUT ALIVE!.

I am here for you. Find me on Pawbly.com and remember "never go quietly into the night."

Free pet advice is available on Pawbly.com.

Parting thoughts;
1. Get Out Alive. Ask about options. Insist on care. Document everything. There is help available even if you have to be insistent on it. This is an emergency condition and your cats life depends on your actions. Be kind. Always be kind. You can't ask someone to be someone you are not.
2. If you do not have any  financial constraints almost every vet and emergency facility can care for your cat with this condition.
3. If you do have financial constraints ask for a written estimate. Go over each line item. Ask which is most imperative at the immediate time. Ask the vet to rank these. Start at number one. Stay at the clinic as each line item is addressed. Once your cat can be transferred to your vet it might be more affordable to get their care with them.
4. Ask about the incidence of recurrence for this condition? Ask how you might be able to avoid this? My advice is a diet and lifestyle change. Less dry food, less poor quality dry food, more exercise, less stress. (Ask about cat stressors? Often clients cannot, and do not see the world the way their cats do).
5. Ask about a PU surgery. Start planning and saving for it. The second, and definitely the third time a cat blocks we put this surgery on the table. This is about GETTING OUT ALIVE! remember. PU surgery info here. Perineal Urethostomy by Michigan Animal Hospital. Cost is between $1,000 and $3,500.

If you have a pet story that you would like to share, or an experience with this condition please add it to our Storyline page at  Pawbly.com.

Please also follow us on Pawbly.com, our Jarrettsville Vet, or our Jarrettsville Vet Facebook page, Twitter @FreePetAdvice, and YouTube

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